Health officials blame heroin for spike in Maryland overdose deaths

Carrie Wells and Kevin Rector, The Baltimore Sun

Heroin overdose deaths soared last year in Baltimore, a city that has struggled with one of the highest rates of heroin addiction in the nation and with the violence that comes with illegal drug dealing.

In 2012, 126 people died in the city from heroin overdoses, a jump of 66 percent from the previous year, when 76 died, reversing recent declines, according to a Maryland Department of Health and Mental Hygiene report released Wednesday.

The new data could confirm the recent warnings from state health officials that a crackdown on illicit prescription opiates was pushing more addicts toward the street drug.

Statewide, fatal heroin overdoses rose 54 percent to 378 in 2012 from 241 in 2011, the department's report said. The spike in deaths was found in all demographics and in most regions of the state, though most pronounced in Baltimore, the study found.

Dr. Joshua M. Sharfstein, secretary of the health department, which warned last fall of a rise in heroin overdoses, called the deadly surge a "serious public health concern."

State and local heath officials vowed to take action after the reversal of years of declines in overdose deaths. The health department is working with local jurisdictions on response plans and sharing information about heroin treatment. The state has several programs that are close to being rolled out.

The state is hosting education programs for medical workers treating people for opioid abuse; training individuals to administer naloxone, a prescription drug that can intervene with a person's ability to absorb heroin during an overdose; and establishing overdose fatality review teams, the health department said.

Christina Trenton, interim CEO for Baltimore Substance Abuse Systems, a quasi-public arm of the city health department, said more than a dozen volunteers will staff the fatality review team, which will delve into the circumstances of fatal drug overdoses and identify if there were missed opportunities to prevent them, and recommend policy changes.

Though the rise in heroin-related overdose deaths coincided with more people switching to the drug from prescription opiates, Trenton said, it was not yet clear if that trend was responsible for the rise in overdose deaths.

"What we don't know is if it's linked to specific overdose cases," she said. "We have to have data that confirms for us that this is the trend that is contributing to overdoses in Baltimore City."

Last year, health officials indicated that more people who had become hooked on prescription opiates like Oxycodone were switching to heroin as law enforcement cracked down on doctors who overprescribed the medication — an apparent nationwide trend that Maryland has followed. But the rise in heroin overdoses comes even as more heroin addicts sought treatment last year.

Baltimore health officials have estimated about 11,200 residents are addicted to the drug.

When alcohol and other drugs are factored in, about 15 percent more people died in Maryland from overdoses last year than in 2011, according to the state study. During the same period, deaths from overdoses on prescription opioids fell by 12 percent, across all demographics and regions of the state, the study found.

The rise in heroin overdose deaths follows success in decreasing the use of the potently addictive drug statewide between 2007 and 2011, health officials said. Baltimore heroin overdose deaths peaked at 283 in 1999.

Christopher Welsh, an associate professor at the University of Maryland School of Medicine, attributed some of the rise to an increase in heroin mixed with fentanyl, a potent anesthetic, in addition to the switch from prescription opiates to heroin. He said a statewide database of narcotic prescriptions is set to go into use next month, making it harder for addicts to "doctor shop."

"Right now there's not a good way for doctors to see if this patient is going to other emergency rooms looking for narcotics as well," he said.

But Welsh said state health officials are trying to get better systems into place to deal with the aftermath of the closing of illicit clinics. For example, he cited an Eastern Shore pain management clinic with 1,000 patients that shut down abruptly in 2011 when the physician's license was revoked.

"Some of them had true pain and they didn't have their doctor anymore," said Welsh, adding that a few ended up taking so much Tylenol to deal with pain that they ended up damaging their livers.

Rachel Indek, also with Baltimore Substance Abuse Systems, and Trenton said federal and state funding for traditional clinical treatment for addiction, like in-patient 28-day programs, in Maryland has been cut in the most recent fiscal year, from about $38 million combined to about $35 million. But they said much of that loss in funding has been made up for in a switch to non-clinical services like peer-to-peer drug counseling.

It's too early to tell whether this approach is working or not, Trenton said.

"I can tell you we have gotten a lot of anecdotal support," she said. "Overall the reception has been positive by the individuals receiving the services."

Erin Artigiani, a deputy director at the Center for Substance Abuse Research at the University of Maryland, said about 1,000 more people sought treatment for heroin addiction in Baltimore in 2012 than in the year before, mirroring a statewide trend. She said those who study substance abuse across the country met recently in St. Louis for a conference and tried to identify the reason for the rise in heroin issues.

"Maryland is not unique in seeing an increase in heroin" use, she said. Artigiani said that the state has faced similar spikes in heroin overdose deaths before, in the late 1990s and then in the mid-2000s, leading to a "renewed effort" to address the issue.

"All of that had some effect back then so I'm hopeful we can do that again," she said.

Baltimore plans to host an "Overdose Awareness Day" in mid-August, city health department spokesman Michael Schwartzberg said, adding that the event would be the first of its kind. It will feature overdose prevention and education training, an information session and a candlelight vigil to remember those who have passed away due to drug overdoses.

On Aug. 9, Gov. Martin O'Malley will hold a roundtable with law enforcement and public health authorities to discuss the issue. The governor has set a goal of a 20 percent decline in drug and alcohol overdose deaths by 2015, DHMH said.

An earlier version overstated the number of heroin addicts in Baltimore. The Sun regrets the error.